American Journal of Epidemiology Vol. 140, No. 5: 461-471
Copyright © 1994 by The Johns Hopkins University School of Hygiene and Public Health
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Risk Factors for Enamel Fluorosis in a Fluoridated Population
From the Department of Behavioral Sciences and Community Health, School of Dental Medicine, University of Connecticut Health Center Farmington, CT.
Reprint requests to Dr. David G. Pendrys, Department of Behavioral Sciences and Community Health MC:3910, School of Dental Medicine, University of Connecticut Health Center, Farmington, CT 06030
The purpose of this case-control investigation was to investigate the possible association between mild-to-moderate enamel fluorosis and exposure during early childhood to Infant formula, fluoride toothpaste, and/or fluoride supplements. Analysis was performed on 401 residents of fluoridated communities in Connecticut, who wore 12–16 years old and born prior to 1980. The case and control subjects for this study were selected on the basis of a clinical examination given in 1991. Subject fluorosis status was determined using the Fluorosis Risk Index. Risk factor exposure was ascertained via a mailed questionnaire with a response rate of 89% and a question naire reliability of 87%. Logistic regression analyses, which adjusted for confounding variables, revealed that mild-to-moderate enamel fluorosis on early forming (Fluorosis Risk Index (FRI) classification I) enamel surfaces was strongly associated with both milk-based (odds ratio (OR)=3.34, 95% confidence interval (Cl) 1.38–8.07) and soy-based (OR = 7.16, 95% Cl 1.35–37.89) infant formula use, as well as with frequent brushing (OR = 2.80,95% Cl 1.15–6.81). A very strong association was observed with inappropriate fluoride supplement use (OR = 23.74, 95% Cl 3.43–164.30). Respectively similar associations were observed between mild-to-moderate enamel fluorosis on later forming (FRI classification II) enamel surfaces and frequent brushing and fluoride supplement use, but not with infant formula use.
dental enamel; epidemiologic methods; fluorides; mottled enamel; risk
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